Provider Demographics
NPI:1386049245
Name:RUSSELL, CINDY HONEYCUTT (OTR/L)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:HONEYCUTT
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2722 NEW TOWN RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-9583
Mailing Address - Country:US
Mailing Address - Phone:704-282-2161
Mailing Address - Fax:
Practice Address - Street 1:2722 NEW TOWN RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-9583
Practice Address - Country:US
Practice Address - Phone:704-282-2161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1335225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist